“Meghan, w-w-w-w-hat are your wishes?” My mother asked, her brain tumor making her speech halting, and, at times, unintelligible. The words that I wanted to say seemed to get stuck in my throat but eventually I was able to cough out “I wish that you could live.” This began one of the many conversations that my mother and I had between the time that she was diagnosed with colon cancer and brain cancer, and the time that she died.

My mother was sick for a long time – six years – before she died. Thus, I had adequate time to think about all of the things I wanted to say to her. As it turned out, my mother had one health crisis after another during those years so I ended up speaking with her a lot. In a perfect world, we would do this in each of our relationships. It would deepen our relationships if we consistently honestly communicated with each other instead of waiting until a moment or two before death. In my mother’s case she was dying a slow death so there was plenty of time to tie up loose ends. In the case of sudden death a lot can be left unsaid unless we have been telling the person all that he or he means to us throughout the relationship.

At any rate, when facing a loved one who we know is likely to die shortly, our own anxiety coupled with the anxiety of the dying person can cause all potential communications to come grinding to a halt. One of the big questions is always: Can we talk with the person about the fact that he or she is dying? We are afraid that we are going to upset the dying person if we speak about his or her death. Often, the dying person finds himself or herself in the same boat. He or she often wonders if relatives know what is happening (i.e. that the person is dying) or whether he or she needs to protect them from this truth. This is an awful bind for a dying person to be in because instead of focusing on what he needs to do for himself during these critical moments, he ends up spending his energy on protecting his loved ones, protecting them from something that they probably already know, that he is dying.

I faced the same dilemma with my mother. One night that I was spending sleeping in the hospice with her she asked me point blank, “Meghan, how is my health?” Not really sure how direct to be, I said, “I am not sure, how are you feeling?” She started screaming, “Oh my God, I am dying” over and over again for what seemed like hours. It felt almost unbearable to sit there and hold her while she screamed out in anguish over the realization of her impending death. At the same time, it was a moment of sadness that we shared. It opened the door to further communications between us. My mother knew that I knew that she was dying and I knew that she was aware of it as well. From that moment on whenever I would leave the hospice in the morning (I would sleep there overnight) as I would lean over to kiss my mother good-bye (which is derived from God be with you) she would say, “I will miss you.” I would tell her that I would miss her too knowing full well that we were not just speaking about the daytime hours during which I would not be with her. I am quite sure that the conversation would have been shut down had I answered her question, “Am I dying?” by saying, “No.” She was testing me to see if we could speak about her death, and by not saying “No” outright I gave her the green light to speak about her fears. This then led to a conversation about our relationship.

People often ask, “What should I say when speaking to a dying loved one?” While we can really speak about anything, some of the things that seem to be most helpful to discuss are providing reassurance to the dying person, asking forgiveness from the dying person (and granting forgiveness to the dying person), telling the person how much you love them, thanking them for various things, reminiscing about the past, and letting them know that you will keep them alive through your memories after their death. As my mother approached death she became preoccupied with a decision she had made that directly affected me. She wanted to reverse that decision but it was impossible. I reassured her repeatedly that it was OK, that I was not angry. I forgave her. She also was worried about me. I was single and she did not want me to be alone as a result of her death. She kept repeating, “Meghan, alone,” “Meghan, alone,” over and over again. I reassured her that I would be okay, that I would not be alone. Neighbors, friends and relatives also reassured her that they would not leave me alone. This seemed to allow her to rest more easily.

A lot of the conversations that loved ones have with the dying are about reassurance, especially when the dying person is leaving young children behind. They need to know that their children are going to get the care and attention that they need. And, while no one can ever fill the role of a beloved deceased parent completely we can work to sew up the gap. My nephew had just been born a year before my mother’s death. At one point she said, “I wish I could see all of the babies.” I said that I wished that she could see all of her grandchildren too. Then, I told her that we would make sure that they knew all about her through us, and through our memories of her. It was in no way acceptable to her or to me that she would not be there to get to know them herself but at least I could reassure her that she would not be forgotten. This seemed to give her some peace. And, it made me feel better that this intense love that I had for my mother did not have to die, but could live on through memories shared with others.

It is best to have these conversations early and often but sometimes that is not possible. It often happens that by the time someone reaches their loved one’s bedside they are in a coma or otherwise seem out of it and unable to communicate. At this point people sometimes feel, why bother saying anything at all, he or she cannot respond anyway. I would urge people to say what they need to anyway. Hearing is believed to be the last sense to go, so often dying people can still hear what people are saying. This theory also applies when you are speaking to others while you are around the dying person’s bed. Do not say anything that you would not want them to hear. My mother seemed to be in a coma for her last ten days of life but I spoke to her anyway. I kept the same routines that I had been keeping prior to that time. I believe that she was aware of my comings and goings, especially because she decided to die shortly after I returned for my evening shift. I believe that her death was something that she wanted to share with me. She knew that I would be able to comfort her and pray with her as she died. She knew that I would tell others about her death. In sharing my experience of her death I would make it meaningful in some way, it was not for nothing. As long as the person is alive, it is never too late to say goodbye.

This blog post has been all about how to “say” goodbye to our dying loved ones. It was sparked by a question from a reader whose brother is dying. While it is important to try to put into words our thoughts and feelings when a loved one is dying it hardly ever feels adequate. Sometimes what is right is to say nothing at all but to simply hold our loved one close as he or she approaches death. Often the work of saying goodbye has to continue after death. We continue to speak with our deceased loved ones. We continue to try to make the ending right in our minds. They continue to be the sparkle in our eye and our lantern for the dark.

I was barely conscious as I heard a bystander shout, “Somebody call an ambulance!” As my body twitched on the floor of a deli in the Bronx, I muttered to myself, “Of course, something like this would happen now, this was the day that I learned that my mother was going to die three years ago.” In my case there was a physical reason for my collapse, however, the psychologist in me knows that physical and psychological health are inexplicably interwoven. They influence and are influenced by each other, often without our even realizing it. Likewise, after the death of a loved one, most people suffer anniversary reactions, which often operate outside of consciousness.

What is an anniversary reaction?

An anniversary reaction is a set of unsettling memories or feelings (anxiety, anger, sadness, fear) that you can trace to an unpleasant event (the death of a loved one, an accident, a robbery, a natural disaster). At times it can be difficult to make the link between the unpleasant event and the feelings you are experiencing for a number of different reasons. Firstly, the fact that this is an “anniversary reaction” can be buried deep in the unconscious and disguised in various ways (as a somatic complaint, as vague unpleasant feelings that are hard to pinpoint). Thus, it might be hard to figure out why we are feeling bad; it can be difficult to link it to an event that might have happened many years ago. Second, sometimes the anniversary reaction happens on the actual date that the traumatic event occurred, while at other times it might be triggered by something else, like the season of the year. When it is linked to a season rather than a day or date, it can take a lot more self-reflection to think about, “Why do I feel bad every summer?” For example, all of my loved ones died between April and July. Summer happens to be one of my least favorite seasons. I wonder if it is influenced at all by having experienced so many deaths in the late spring and early summer. It is almost as if as spring ends I feel the need to brace myself for whatever catastrophe summer might bring.

Experiencing an anniversary reaction is a normal part of the grieving process. All that it means is that the traumatic event has not been fully processed yet; something from your past is asking for attention. Once it is “worked through” the anniversary reactions should become less and less intense until they no longer carry the same power.

What can we do if we suspect that we are experiencing an anniversary reaction?

1) As each month begins think about the significant dates so that you are prepared, and so that if you start to feel out of sorts you know where it is coming from. Having an idea of the past event that is causing your current bad feelings can help you to process them. Remember that you can experience an anniversary reaction on the days leading up to the significant date or anytime during the season of the year that a trauma occurred.

2) When you are experiencing an anniversary reaction be sure to find an outlet to express your memories, thoughts, and feelings. You can do this through speaking (to trusted friends or a therapist), writing, painting, drawing, making music, or praying. The goal is to try to put words to, to try to express in some way, your trauma, and what it meant for you and your life.

3) Make a special effort to take good care of yourself while trying to work through a trauma. Eat a lot of fruits and veggies, drink plenty of water, and make sure to get enough sleep each night. If you feel like you are drowning in your trauma, seek out the help of a grief or trauma specialist. It often helps to have a steady companion as we journey through the darkness of our trauma to the light on the other side.

Have you ever experienced an anniversary reaction? If so, what was it like? How did you get through it?

I appreciate that so many people are taking the time to read my posts. I will continue writing about my interests but I am also interested in addressing your questions and concerns. In an ideal world, I would like this to be a discussion about death and dying. So, if you have any comments or questions, please feel free to ask, either in the form of a comment below or, if you feel more comfortable, via email: docmeghan@gmail.com! Thanks!

In the weeks following the death of Elizabeth Edwards, there has been a lot of concern and questions expressed regarding her children, especially her youngest children, ages ten and twelve. Almost without fail, at the end of a news story about the Edwards’ family the commentators ask, “How are the children doing?” Really what they are asking is, “Will the youngest children be all right?” It is an understandable question. Given that the death of a loved one is so overwhelming for adults, how do we expect children (who seem so much more vulnerable) to cope effectively, especially after the loss of a parent? While it is impossible to say at this point whether the Edwards’ children will be “all right,” I can tell you what makes for a better outcome after the death of a parent.

1) Be Honest With the Children: If a parent is dying do not hide this from the children. The misconception is that by not telling the children the bad news that their parent is dying we are protecting them. In reality, what we are doing is confusing them. Children are very perceptive. They can see that something is wrong with their sick parent. When the people close to them refuse to discuss it or, worse yet, deny that anything is wrong, children feel confused and, at times, left out. Sometimes it is up to the parents to bring up the topic and to discuss it in an age appropriate way with their children but often the children will bring it up. When my father was dying, I asked my mother directly, “Is dad going to die?” She said, in an exasperated voice, “Oh, Meghan, we are all going to die someday.” She did not say yes or no but avoided the question. Her exasperated voice made me feel like I was being silly to ask. It was at that moment that I started to doubt my intuition and my judgment. I have since recovered, but it would have been more helpful had my mother just been honest, had she been able to confirm for me that my father was going to die. When a loved one is dying, during the months leading up to the death, (whether they realize it consciously or not) the surviving family members are preparing themselves, bracing themselves for the death. It is only fair to give children this warning to “get ready” as well.

2) As the Dying Parent Approaches Death Let the Children Know That the End is Near and Give Them the Option to Say Goodbye. When a family has been discussing the fact that a parent is dying throughout the days leading up to the death, it makes it a little easier when you have to tell the children that death is imminent. At this point the surviving parent (or other concerned adults in the child’s life) should tell the child what his or her parent looks like now. Be sure to let them know if medical devices are in place or if the parent looks a lot different then when they saw him or her last. The goal is to have the child prepared as well as possible for that last visit with his or her parent. If at this point children say that they do not want to go see his or her parent do not force them. Most children know what they can handle. If they say that they do not need to say goodbye, respect that wish. Even for the well-prepared child, going to say goodbye to a dying parent can be overwhelming and traumatizing, being forced to go say goodbye is doubly traumatizing. Also, if the child decides to go to say goodbye be sure that there is someone there who can take the child out of the room (or home) if the situation becomes too much for the child to bear.

3) After a Parent Has Died Tell the Children Directly and Avoid Using Euphemisms: Whether a death is sudden or expected, soon after it happens it is important to tell the children. It is best to sit them down in a quiet place and tell them directly, “Mom died this morning.” Often, with children, adults have the tendency to use euphemisms such as “Jesus took Mom to heaven last night.” We think that this will in some way lessen the blow of the loss. In reality, what it does is makes children afraid that Jesus is going to come for them the way that he came for mom. At this point each child will have a different reaction. Some will cry, others might faint, and a few might have no obvious reaction at all. The job of the adults at this point is to provide comfort and reassurance, and to answer questions. Some children might want to go outside to play with their friends or to be alone. Parents should allow this to happen as each child processes a loss differently. It is very common for children to grieve in dribs and drabs. One moment they might be crying over their dead parent while the next they might be outside playing with friends. It is important to give grieving children some space while being sure to check in with them periodically as well.

4) Let Children Decide Whether or Not They Want to Attend the Funeral Services: It is important to let children have a say in whether or not they want to attend the funeral service for their deceased parent. Many children will want to attend and some will even want to play an active role (i.e. do a reading, etc.). If the child decides that he or she does want to go to the services, it is important to prepare him or her beforehand for what he or she will experience (see, hear, smell, touch) at the services. It is a good idea to have somebody with you who can take the child outside or home should the service become too overwhelming. Many of the people I have spoken to reported that it was comforting to be at the services for their deceased parents but others told me that it was overwhelming, traumatizing, and embarrassing. Whether or not the child’s presence at his or her parent’s funeral is going to be helpful or hurtful depends a lot on the child’s personality, the support provided during the service, and the preparation he or she received beforehand.

5) As Much As Possible Keep Everything the Same: When a parent dies young, leaving a family behind, often the survivors feel as if the rug was pulled out from under them. One of the things that parentally bereaved children reported as being the most helpful was when their surviving parents were able to keep routines, homes, schools, as much the same as possible. Sometimes this is not possible due to the financial changes that happen when a parent dies, particularly the death of a father. But when it is possible, keeping things the same seems to provide a sense of safety and continuity for grieving children. Unfortunately, a lot of adults (including adults in my own family of origin) have this feeling that they want to change everything to mark symbolically making a new start after the death. Eventually, this might be a healthy thing to do but to do it too quickly can tend to disorient children. At the same time, I am not advocating that we hold on to rituals rigidly. If, for example, it is too hard to sit around the dinner table without the beloved parent, it is adaptive to change where you eat dinner. For many of us losing a parent is enough without adding the loss of a home, school, routine, to the mix. Changes can be made but they should be made slowly, over time, rather than all at once.

6) Provide a Safe Place For Children to Process The Loss: Immediately, after the death of a parent everything tends to be turned upside down, there are not enough hours in the day to get everything done, and yet there are still children who need help processing their grief. As a rule, children cannot process their grief without the permission and the help of adults. So, what is a surviving parent to do? This is a hard time. As much as possible, rely on your community, your support network, for help. Hopefully, you have friends and family who pitch in without being asked. If not, reach out to your family, friends, and church to try to garner some support. Some people will not be willing to help (even when asked) but many people will be glad to help. I have often been surprised at who comes through in a time of crisis (and who fails to help). Once people agree to help allow them to do the food shopping, driving children to after school activities, cleaning, and food preparation. Having a break from the regular duties of running a household will allow the surviving parent some time to process his or her own grief and to attend to the emotional needs of the children. At times, for various reasons (most often not wanting to upset the surviving parent), the children do not want to speak to their parent about the death. This is yet another role that the helpers can fill. A concerned family friend can provide a listening ear for a grieving child. Children need people to contain their anxieties, provide a listening ear, help them to make sense of their thoughts and feelings, and to offer reassurance.

As a psychologist I would be remiss if I did not suggest seeing a therapist in individual, group, or family therapy as a worthwhile endeavor to help the child and/or family to work through his or her grief. This is something that is certainly not necessary for every bereaved child or family but some people, some children, do find it to be helpful to have a safe place to go to explore all of their feelings and thoughts surrounding the death of their parent and all of the changes and new challenges they have experienced as a result. Children have a lot to negotiate when a parent dies including how to interact with their peers now that they feel fundamentally different and how to negotiate new responsibilities they may have to take on at home. It can be tremendously helpful to have someone in your corner who is not affected by the death of your parent during this time of change. Children often have a hard time speaking with their surviving parents for a lot of reasons including not wanting to upset them – this is not something that they have to worry about with a therapist. Many of the adults who I have spoken to expressed that they wished that their parent had found a competent therapist for them when they were newly bereaved. It is always better to catch a problem with adjusting to the death of a parent early rather than letting it play out and influence the course of one’s life in so many different ways.

7) Try to Make the Transition Back to School Smooth: As a rule, following the death of a parent, many children immediately feel different from their peers. This makes for a difficult transition back to school. Most children are out of school for at least a couple of days after their parent dies. When it is time to return the surviving parent and the child need to negotiate a way to make the move back to school as easy as possible. Often, it helps if the parent can contact the teacher and let him or her know what has happened. The parent should also ask the child how he or she wants the death of his or her parent to be handled at school. Some children are embarrassed if it is spoken about in the classroom, while others feel hurt if their parents’ death is not addressed. While they are not therapists, finding an ally in a teacher, someone who can listen to the bereaved child, can go a long way in healing a broken heart.

Commemorate the Dead Parent: Some children find it to be helpful to commemorate their deceased parent in some way, while other children want nothing to do with it. While children should not be forced to engage in these activities they should be given options for symbolizing their relationship with their deceased parents. People can commemorate their loved ones any way they want. Some children enjoy going to visit with their deceased parents at the cemetery. Other popular methods of remembering dead parents are through making scrapbooks and memory boxes. A memory box is a box within which they put different items, belongings, pictures, and memories of the deceased parent. It helps children to remember and to feel closer to their dead parents. It also gives them a forum within which to express and to explore their grief. Other children prefer to create a scrapbook of pictures and memories of their deceased parents. Some children want nothing to do with either of these activities. This is perfectly acceptable and to be respected.

While the loss of a parent during childhood is one of the most stressful and potentially traumatic events a child can experience, it will not necessarily result in a catastrophic outcome for the children. With the proper support children can not only survive but thrive after the death of a parent.

Those of you who were bereaved in childhood, what was the most and least helpful in terms of helping you to cope with the loss of your parent?

So, you have a list of names and you are thinking of contacting therapists. What is the next step? First, timing is really everything. When a person decides that he or she wants to see a therapist it should be because he or she is ready to engage in therapy. Often, people show up on a therapist’s doorstep because someone else in their lives thinks that they need “help.” While this is not a bad reason to consider therapy (and if you are the friend or loved one it is not bad to make the suggestion of therapy) when a person actively begins a search for a therapist it should be because he or she wants it. While it is also important that the therapist desire to work with the patient, the therapist’s desire alone is not enough to keep the therapy moving forward. If the patient does not want the therapy, the therapy will likely fail.

What should I look for in a therapist? Just like in many other facets of life the most important thing to look for in a therapist is that there is a “good fit” between you and the therapist. I have heard of many instances in which the therapist was very competent and the patient was willing, however, the therapy did not work out well. The therapy will not progress if the therapist’s style or personality does not match what the patient needs. Therefore, it is important that you make a list of qualities that you will be seeking in a therapist. Do not settle. If you do not feel completely comfortable with the therapist you are seeing (outside of the normal anxiety that accompanies speaking about deeply personal issues), look for another one. There are a lot of therapists out there. I have known far too many people who have stayed in therapy too long with therapists with whom they were not making any progress.

During your first appointment, ask questions. Gather information about the person’s therapeutic style. What is his or her therapeutic approach (i.e. cognitive behavioral, psychodynamic)? Has he or she helped people with your problem before? If so, how many people and what was the outcome? How many years have they been practicing? Also, make sure that you understand the therapist’s policies and procedures. What is the fee for a therapy session? Does the therapist take your insurance? What is the policy if you have to miss a session? Finally, ask the therapist about his or her credentials. What type of training does he or she have (Ph.D., M.S.W, M.A., etc)? Upon asking some of these questions, if the therapist becomes overly defensive or critical of you, I might look for another therapist. At the end of your search for a therapist you want to make sure that you have found one that is credentialed, professional, and a good fit for you. Do not stop looking until you have found a therapist who meets these requirements – it will make the difference between a mediocre therapy experience and a wonderful one.

After the death of a loved one we can feel a whole range of emotions for a long time. People commonly report feeling sad, angry, lost, relieved, lonely, depressed and anxious. Sometimes we might even find ourselves laughing and crying at the same time. Our moods can sometimes be so volatile, after the loss of a loved one that we might feel as if we are going crazy. These are normal grief reactions, but if you find that your feelings are unbearable to handle alone or if close friends or family members are suggesting you “need help” you might decide to seek out a therapist. Often, people are not sure how to go about finding one. Below, I am going to list four routes that people often follow when seeking a therapist.

1) Some people speak with their primary care physician. This is an objective party who can listen to your experiences. He or she might also be able to discern whether you would benefit more from a psychologist or a psychiatrist. Once this decision is made your primary care physician will hopefully be able to recommend some reputable therapists in the neighborhood.

2) Other people want to use their insurance so they go to the website of their insurance company and pick a therapist from the list of providers. Some people I know have had luck doing this while others prefer a recommendation or referral to a therapist from someone they know. When looking over the list on the website of your insurance company you might want to call up the insurance company to make sure that all of the providers are listed on the website. Surprisingly, often for one reason or another, some providers are missing. At any rate, when choosing a therapist, you want to make sure that you know all of your choices.

3) Asking family and friends if they know of a therapist can also be helpful. Sometimes people take the list of providers from their insurance company and ask people they know if they know anybody on the list who they would recommend. Better yet, some people ask their friends and family members if they know of anybody in the mental health field who knows anybody on the list who they would recommend.

4) Sometimes calling up schools with psychology or psychiatry departments and asking for a referral to someone trained at their school will yield good results. It is unlikely that someone working at the school is going to give you the name of someone not worth his or her salt because that would reflect poorly on the program.

Often the hardest part of finding a therapist is getting over the perceived stigma of going to therapy. I urge anyone who is having a difficult time picking up the phone for this reason to find a way to get over it. You can discuss worries about being stigmatized, and what it means to see a therapist, in your first session. The payoff for overcoming your apprehension will make the discomfort at the beginning of therapy more than worth it. One of the main determinants of whether the therapy is going to be a good experience or a mediocre one is whether or not you find the right therapist for yourself. I am going to speak more about this is my next blog entitled: What to Look For in a Therapist.

Not everyone who has lost a loved one, necessarily needs grief counseling, however, if you find yourself experiencing one of the symptoms below, you might want to consider it. The duration and intensity of grief is different for everyone. Contrary to popular opinion, this writer believes that grief continues in one form or another for years after the loss of a loved one. In general, people seek out therapy when they are not satisfied with their lives or the way that they are feeling or functioning in the world. If you are experiencing any of the symptoms below it makes sense for you to seek out the opinion of a professional therapist. Some people also find it to be beneficial to seek out a bereavement group because this allows them to share their experience of loss with other individuals who are going through the same thing.

1) If you have thoughts of hurting yourself or someone else you should tell someone you trust and make an appointment to go speak with someone about your painful feelings and experiences. These thoughts of your own death are often accompanied by the thought that you cannot go on living without your loved one.

2) If your grief is so strong that it is preventing you from going on with your normal activities (i.e. you are not able to concentrate, sleep, eat, socialize, work, as you normally would) seek someone out to help you to process your grief.

3) If you feel so hopeless and depressed that it is difficult for you to work or socialize, speaking to a therapist will help you to explore what feelings you are turning in on yourself that are contributing to making it difficult for you to function.

4) If you feel so anxious that it is detracting from your ability to enjoy life or get the things done that you need to accomplish, speaking to a counselor can help you to relax.

5) If there is a sudden change in your behavior (i.e. drinking more than you used to) you might want to contact a counselor to explore what purpose the change in behavior (in this case alcohol) has been serving in your life since the death of your loved one.

6) If you hear voices when nobody is talking or see things that nobody else can see, it is a good idea to let a trusted family member or friend know, and to seek professional help.

Do you have experience working with a therapist? If so, was your experience positive or negative? If you have never been in therapy, what are some concerns that you have? Next time, we will speak about how to find a therapist and what things to look for in a counselor.

What if I don’t feel “up to” doing Christmas (Hanukah, Thanksgiving, New Year’s, etc.) this year? This is a common question that I get around the holidays. Holidays can be stressful under the best of circumstances, when a person is grieving it can be hard to get out of bed. There are numerous reasons that the holidays can be difficult for the griever. First, many people report that they fear that it will be too hard going to a celebration without their loved one. Second, sometimes the death of a key family member (especially the mother) will change the holiday all together. If she used to host it, now it is up to someone else to carry the mantle. Once somebody volunteers a lot of questions arise about whether to continue past traditions or to create new ones. Finally, in some circumstances, people are left alone for the holidays after the death of their loved ones. The people who they normally would have celebrated with have died, and now they are alone.

Firstly, I think that if someone really does not want to celebrate the holidays they should not feel pressured into it. Some people are fine by themselves for the holidays; in fact, in some cases, they prefer it. For this group of people it would be wrong for them to go to a holiday celebration. When people do things they do not want to do negative consequences can occur. At the very least, they resent being pressured into doing something they do not want to do, at worst they become overloaded emotionally, get upset at the event, and get labeled as “unstable” or worse (when in all likelihood what they are experiencing is a “normal” grief response), by the partygoers.

When the question of whether or not to continue family traditions arises after the death of a “key” family member, families can become divided. After the death of our mother, my brother and I decided to mostly keep our Christmas traditions as a tribute to her although we did tweak them a little to fit our needs and desires. In short, we decided to keep what we enjoyed about Christmas while growing up. Anything that was no longer working for us we abandoned. For some families creating new traditions is a way of moving on after the death of a close family member. There is no right or wrong, what is most important is that everyone feels comfortable with the decisions that are made about how to celebrate the holiday.

What if, due to the death of a family member (or for any other reason), you suddenly find yourself alone for the holidays? Well, if you are comfortable being alone there is no issue. I personally feel that too much is made out of the need for togetherness because it is a holiday. For me, a holiday is whenever I see friends or family who I love. It does not really matter whether it is December 25th or the middle of the summer. Of course, this viewpoint probably arises from having grown up in a small family that I was separated from on some of the holidays (for varying reasons) over the years.

If the person really does not want to be alone there are a number of options. First, he or she could call up friends and ask if he or she could join the celebration. Often, this works, most people have a “the more the merrier” attitude towards the holidays. If this does not work (or for some reason is not desirable), getting out of town for a few days (either with an organized group or alone) is often fun or is at the very least a distraction. Some people do not feel compelled to leave town but instead create a plan to have fun by going to museums, the movies, or a spa to name a few options. Another possibility is to do some volunteer work such as serving food in a soup kitchen. Giving back to others tends to make people feel fulfilled. It also reminds people to be grateful for what they have. If none of these things sound interesting, stimulating, life-giving, then I would advise the person who is dreading being alone on a holiday, to do whatever gets you through the night. This will be different for each person. It might mean catching up on sleep, watching videos, phoning people in different parts of the country to wish them a happy holiday, or creating a work of art. Just remember that it is just one day, really a day like any other, and tomorrow it will be over.

Even for the seasoned mourner, it is hard to know what to say or do when someone close to us has lost a loved one. Often, we resort to using trite platitudes like, “She is in a better place,” because this is what we have been taught, this is how we have been socialized to respond when someone loses a loved one. Sometimes responding this way only serves to anger the griever or makes them feel misunderstood. At times, the response grievers receive from others is far worse than someone using a trite platitude. Some people pressure grievers to “get better” far too quickly while others avoid the bereaved altogether. These people are not trying to be mean, most of the time they do not know how to deal with loss themselves. They feel helpless in the face of loss so they say something insensitive or avoid the bereaved. Unfortunately, the person dealing with the loss can end up feeling criticized when people say, “You have to try to be positive.”

Honestly, none of us can ever fully understand how a person is feeling when his or her loved one has died because we are not that person. We might be able to imagine how we would feel if our loved one died but since we are not the bereaved person we cannot fully understand.

In my opinion, a better approach is to follow the cue of the griever. Most of the time they need people to be with them in their pain, not people who are going to try to take their pain away. This is a more difficult approach because we have to be willing to “be with” whatever feelings the grieving person might express. This means that we have to be able to contain our own feelings as well as whatever feelings the other person might share.

There is no hard and fast rule for how to best respond to someone when his or her loved one dies because everyone grieves differently. As a result what might be a good response for one person could fail miserably with another. What is most important is that we listen carefully to the grieving person. We cannot, solve the problem that they are facing, we cannot bring their loved one back from the dead, however, we can provide a space within which they can express their many and sometimes conflicting thoughts and feelings. Listening to someone who is grieving serves to legitimize his or her feelings. It is healing to know both that you have been heard and that you are not alone in your pain.

Besides benefitting from a good listener, grieving people often need help (especially right after the death) with chores. They might need someone to help with food shopping, cooking, or cleaning. If it is a parent who died, the grieving spouse will also need help with child-care so that they can have time to both process their own emotions and to tend to the many things that need to be handled when someone dies. And, as Kathleen pointed out in her comment, some grieving people need someone to go out with them and to distract them from their loss for a while. These are my thoughts on this issue but I want to hear from other people. So, when you were grieving, what did you find to be most helpful?

Many people who are mourning resist acknowledging their grief. This makes perfect sense. Why would we want to think about something that is going to make us feel miserable? One common way of trying to block out grief is by keeping ourselves very busy. If we are constantly running from place to place we hardly have time to think about the things we have lost. Another thing that we tend to do if we are trying to deny grief is that we avoid any situation that might trigger it. This really limits our ability to live our lives to the fullest. Despite our best efforts to deny it, grief will pop up anyway but it will often take a less direct route. Once it goes underground, grief might appear in the form of physical symptoms. If you do not feel sad but are having headaches, chest pain, stomach aches (or any other physical symptom) it might be your grief, making an appearance, asking to be acknowledged.

2) Grieve In Your Own Way

Dr. Kubler-Ross popularized her five stages of grieving (denial, anger, bargaining, depression, acceptance) in her work with dying patients. Over time, these stages began to be applied to the grieving survivors as well. I feel indebted to Dr. Kubler-Ross. When I first read her in college, I felt relieved. Finally, someone who acknowledges the need to speak about death openly! The Death and Dying class that I took was life changing and was by far my best college class, however, I left there thinking that all people who are dying (and all grievers) go through the five stages of grieving. In the intervening years, I have learned that this is not true. Perhaps, the most salient example, occurred when my mother discovered that she had metastatic colon cancer. While at times I thought that she seemed to be in denial, bargaining, angry, and depressed, what struck me the most is that she made a commitment to survive. She never accepted her death. On the contrary, she was determined to fight for her survival, and this is what she did every day until the moment she died. The lesson for us here is that although we can read what people have to offer about death and dying or grief and grieving, we have to listen to ourselves and do it our own way, whatever way that happens to be. Listening hard to ourselves will tell us where we need to go and what we need to do.

3) Write It Out

One of the best ways to process grief is by writing about it in a blog or a journal. They both have their benefits. A blog allows us to help others through our experience and helps us to feel less alone as people respond to us, while a journal (that should not be read by others) gives us a safe space to express and explore all of our feelings and thoughts without having to censor. Once we have written it out, we end up in a different position with regards to our grief. It is no longer so mysterious. It is no longer so powerful. Some people really do not like to write. Other ways of expressing ourselves are through drawing, painting, sculpting, praying, and making music. The medium is not all that important what is crucial is that we find a way to give voice to our grief. As William Shakespeare said in Macbeth, “Give sorrow words. The grief that does not speak, whispers the o’er fraught heart, and bids it break.”

4) Share Your Grief with A Safe Person

Once we are able to articulate our grief it is often helpful to find a “safe” person to speak with about it. I emphasize “safe” because one of the worst things that can happen is that you pick the wrong person and they keep shutting you down. I have had this happen several times. As soon as I started talking about my grief over my mother’s death, some of my friend’s said, “You have to be positive” or “She is in a better place.” I find this to be infuriating. Sometimes grief support groups can be helpful because this is a group of people who have all experienced the same thing, the loss of a loved one. Finally, some people decide to consult a therapist. Ideally, a competent therapist should be non-judgmental, caring, and should be able to help facilitate the exploration of grief. Henri Nouwen once said, “The friend who can be silent with us in a moment of confusion or despair, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not healing, not curing . . .that is a friend indeed.” This is what we are seeking, when we are grieving, a place to go where we can simply be ourselves, whoever we happen to be at that moment.

5) Take Good Care of Yourself

Grief is hard work. It takes a toll on our minds and our bodies. During this time it is important to take especially good care of ourselves. Be sure to get enough sleep (8-10 hours a night), eat a nutritious diet, drink a lot of filtered water, and get at least thirty minutes of exercise a day (with your physician’s permission).

6) Read Books or Articles About Grief

Some people find it to be comforting to read books about either other people’s experience of grief or about grief and recovery. I am developing a Resources page that I will be posting shortly. Here, I will list all of the books, movies, and songs that I have found to be helpful over the years. Do you know of any books on Death, Dying, or Grief that you have found to be helpful?

7) Memorialize the Deceased in Some Way

Many people report that they have found paying tribute to or memorializing their deceased loved one in some way to be healing. We can do this in all kinds of different ways. The athlete may run or bike while raising funds for a worthy cause in his or her loved one’s name. The writer might create a poem or a book as a tribute to the deceased. Some people prefer to make a collage out of pictures of their loved one. The philanthropist often contributes money to a worthy cause as a way to honor someone who is no longer alive. There are many ways to remember the dead. After my mother died, I felt compelled to research my family history to understand where I came from and to frame where I am going. I also wish that I had a garden. In it I would plant different flowers and bushes that my dead relatives loved. Whenever I would look out the window or tend to the flowers I would be reminded of my loved ones who are no longer physically with me. Do you memorialize the dead? If so, how? Does it feel helpful?

Back to Life, Back to Reality

Eventually, slowly, over time, part of “working through” grief has to do with getting back to our lives. Bit by bit we have to try to re-emerge from our grief cave. First, we should try to attend things that feel the most supportive to us. If there was something we really loved, perhaps a yoga or meditation class, we should try returning there first. If it goes well, then we can make this a part of our weekly routine again. If it just doesn’t feel right we can hold off and try again sometime in the future, or maybe it just is not a good fit anymore. A lot of people tell me that they feel most supported in a religious setting, a church service or something similar. There they gain both the support of the community and peace from the familiarity of both scripture and religious principles. Many other people, however, feel irritated and angry with God after the death of a loved one. Church is the last place that they want to be. At this point in the grieving process there are no “shoulds.” There is nothing that we “should do,” what we need to do is whatever will nourish our soul and our spirit. It does not matter what other people think is best for us, what is important is that we do what we want to do, that we do what is most healing for us.

9) Create a New Reality

After the death of my mother I kept having the image of myself putting on my hiking backpack and taking off with only what I could carry. The image felt liberating. It felt freeing to walk into the woods, leaving all of the suffering I had been experiencing behind. Of course, I did not do it but the idea that I could gave me comfort. What was this about? After someone close to us has died, nothing is the same. I think that sometimes we feel compelled to do radical things, indeed, we may need to do them, to close the chapter of our life with our now deceased loved one, and to usher in a new beginning. The deaths of important people in our lives place us in new roles and allow us the potential to develop a different kind of meaning in our lives. We have all heard of people who move, make renovations to the house, or get remarried shortly after the death of a spouse. Sometimes it has to do with filling a gap, an emptiness that was left by the deceased, but often it is a symbolic representation of a new life, a life without the mother, father, brother, sister, son, daughter, who was so very important to us. After the death of a loved one, did you discover that you were creating a new reality for yourself?

10) Maintain Bonds With Your Deceased Loved Ones Freud and many generations of clinicians after him taught that to keep an attachment to our dead loved ones was pathological. When I first heard this theory, this way of thinking puzzled me. Is it really possible to sever the connection with someone you love? Is it always pathological to keep an attachment? At times my connection to my dead father felt helpful. Thus, I set out to study more closely whether people remain bonded to loved ones after death, what forms these bonds take, and whether people find them to be helpful or hurtful.

In their groundbreaking book, Continuing Bonds, Klass, Silverman, and Nickman reported that both children and adults keep a connection with their deceased loved ones. They (1996) assert that it is “normative for mourner’s to maintain a relationship with the deceased” (p.18). The authors suggest that a process of adaptation takes place in the relationship after death whereby new connections with the deceased are constructed. Instead of emphasizing letting go of the deceased, they stress renegotiating the loss over time. They have come to view mourning as an ongoing “accommodation” in which the bereaved person will connect with the deceased person in different ways throughout his or her life.

Contrary to Freud’s belief that keeping a connection was “pathological,” in his book entitled Fatherloss, (2001) Neil Chethik observed that men who had maintained an internal relationship with their father’s after their father’s death were often most at peace with the loss. Chethik (2001) says, “Through this ongoing connection, these sons seemed to gradually work through any pain, anger, or regret. After that, they were free to focus on the appreciation they felt towards their father, to celebrate his life and their own” (246).

Thus, I reassure people that it is not necessarily unhealthy to maintain a bond with our dead loved ones. It is quite common for people to have conversations with people who have died or to keep some of their belongings. It is impossible to completely sever the tie to someone who lives on in our minds and hearts. Do you keep connections with your deceased relatives? If so, how?

So, what might we experience when we are grieving? Especially in the days immediately following the death of a loved one some people feel numb, they cannot believe that their loved one died. This is not necessarily a bad thing, it is our minds way of protecting us, by allowing us (when we are ready) to process the horrifying news in bite-size, manageable doses. One of my patients once told me that at the time of her mother’s death she had to deny it because “I just wanted everything to be the same.” I think that denial is the most human instinct. None of us want to believe that our loved one is gone. It is just too painful and the ramifications for us are far too frightening. Especially when it is a spouse, child, or parent, the implications for the survivors are far-reaching. Nothing is ever the same after the death of a loved one. We are never the same. How could we be? In A Grief Observed, C.S Lewis commented on this phenomenon (as he experienced it) when he compared grief to someone who has lost a leg. He says that the person might get over the loss of his leg in the sense that the stump will heal but not in that they will ever be as they were before. Neither will we ever be the same after the loss of a loved one.

On the other side of the spectrum are the folks who are either fighting accepting the death through being angry or who are furious because the person died. These people tend to be in a rage. This is a very common response, as it should be. People who have lost a loved one have a lot to be angry about. It seems so unjust. The questions are unrelenting, “How could this happen to us?” “Why did this happen to us?” “What did we ever do to deserve this?” Sometimes it can be hard to know where to direct our anger. For some people it lands in God’s lap, while others get angry at the deceased or at the doctors, still others turn their anger in on themselves. The death of my grandfather when I was seven was one of my first experiences with the loss of a loved one. I will never forget that when my father arrived to tell my mother that her father had died, she slapped him! Although few of us resort to physical violence, many of us lash out (or want to lash out) with our tongue when we are grieving. This is a completely normal reaction to the loss of a loved one. I think that lashing out prevents us from feeling the pain of the loss that we are not able to bear at that point.

Still other people suffer from feelings of guilt. They blame themselves for the loss they have experienced. These are the people who say, “If only I did A, then B would not have happened.” They also might review the relationship and discover something they did or did not do that they now feel guilty over. On an unconscious level claiming responsibility for the death makes the person powerful. For most of us, as counterintuitive as it may be, feeling powerful and in control, even if we are holding ourselves responsible for a death, is a better feeling, then acknowledging that we were totally helpless, in the face of a loved one’s suffering and death. We wish that we could have control over matters of life and death, that we could have prevented the death of our loved one. I will never forget spending the night with my mother at the hospice while she was dying from cancer. Over and over again, she screamed, “Meghan, help me!” It was a terrible feeling knowing that there was nothing that I could do to save her life, all I could do was to hold her and to try to ease her pain.

Feelings of being overwhelmed, anxious, and afraid also emerge while grieving a loved one. Sometimes it is hard to know exactly what we feel, the feelings become so intertwined. C.S. Lewis commented on his own experience of grief: “No one ever told me that grief felt so much like fear. I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the same yawning. I kept on swallowing” (1961, p. 7). Immediately following the death of my mother I felt very restless. I did not know what to do next, could not sleep, and was very busy doing things that did not necessarily need to get done. This is what sometimes happens when we are grieving.

Some people find that they cannot stop sobbing and they feel completely exhausted. Sometimes this yearning for the lost loved one takes the form of thinking that you are seeing them or hearing their voice. At other times, the bereaved might pick up the phone to call their loved one only to realize that sadly, they are gone. During this period of preoccupation with the deceased the bereaved might lose interest in everything else such as friends, work and food, to name a few things. People often report feeling physically ill. At times, grievers say that they feel faint, sick to their stomachs, or that their chests hurt. Grief can mimic depression. Hang on, it will get better, you will get through this.

While grieving, not everyone experiences all of the things I mentioned above, but many of us experience a lot of them at different times while processing our grief. Sometimes we have several different feelings simultaneously and at times we have feelings and thoughts that I have not mentioned. It is impossible to name everything that grief encompasses since we are each unique and grieve in our own way. What has your experience with grief been?

Once we emerge from being bombarded by grief, what we need to figure out next, is how we will go on, how will we continue to live without our loved one. Next time, I will offer some suggestions about how to “work through” grief.